Medical Personnel Can Save More Lives by Screening for Oral Signs of Disease

Most of us may not view the dentists and dental hygienists as lifesavers, but Dr. Gwen Cohen-Brown differs in her view. She is an assistant professor of dental hygiene at New York City College of Technology.

Dr. Gwen is on a mission to routinely conduct periodontal evaluations and oral cancer and vital sign screenings as well as how to recognize the clinical signs of such systemic diseases as HIV/AIDS. She also persuades her students, hygienists, physicians, physician assistants, nurse practitioners and hospital HIV/AIDS counselors to follow the same.

"Dental health providers can be the first line of care when it comes to oral health," she says. "The mouth is the portal to the body and a reflection of general health. We as health providers need to be able to recognize things like a yeast infection that doesn't go away or specific tumors and be able to bring up such subjects with our patients."

Statistics bear out her concern. According to the American Dental Association, only about seven percent of dentists offer the mouth and neck exams they should.

Dr. Cohen-Brown, who became a dentist in the mid-1980s when the AIDS crisis reached epidemic proportions and saw many patients with HIV/AIDS, makes this point when she speaks at hospitals, prisons, clinics, health care conferences, training programs and rehab, medical and mental health centers in the tri-state area, which she does as often as time permits. She also offers in-person health care provider continuing education on HIV-related topics through Cicatelli Associates.

"While HIV/AIDS is no longer in the news as much, it is still an epidemic that needs to be contained, and education is key," she explained. The New York City case rate of 45.4 per 100,000 people is more than three times the U.S. average and 45 times the target goal for Healthy People 2010, a set of health objectives for the nation to achieve over the first decade of the new century. Particularly hard hit are the city's Black and Hispanic populations, which account for 81 percent of new HIV diagnoses, as reported this past September by the New York City Department of Health and Mental Hygiene.

Dr. Cohen-Brown explains to providers the laws about HIV testing, what occurs in pre-counseling, and the types of tests available. Dentists can't do HIV testing (New York State has strict requirements about providing counseling with testing), but can refer patients to clinics, hospitals and agencies such as the Brooklyn AIDS Task Force that perform confidential or anonymous testing, especially the Rapid HIV Test, which delivers negative results in 20 minutes.

Just as importantly, she informs her audiences on how to bring up the subject of HIV/AIDS testing -- where to refer patients, how to help them access those places, what needs to be done and what to expect.

And since success in steering patients to HIV testing may hinge on the ability to remain nonjudgmental, she also gives her audiences examples from her former oral pathology practice on how to approach patients in a way that won't make them panic. "The more comfortable you are, the more comfortable they'll be," she says. "You have to know which questions will elicit answers. As long as I'm not judgmental, the patient will be comfortable."

Dr. Cohen-Brown, whose advanced studies in oral and maxillofacial pathology led her from dental practice into teaching, works with the AIDS Institute, the New York State Department of Health and the Department of Corrections, lecturing on mandated cleanliness standards, equipment maintenance, exposure prevention, infection control, post-exposure medication and how the HIV Rapid Testing kit works.

In addition to all her teaching and the workshops she conducts, Dr. Cohen-Brown recently was featured in the Audio Conference on Oral Health and Pregnancy, which went out to community health workers at 80 sites throughout New York State. She actively participates in statewide teleconferences for health care providers working for the New York State Department of Corrections, sponsored also by the New York State Department of Health's AIDS Institute and Albany Medical Center.

Since joining the City Tech faculty in 2004, she has been teaching the College's dental hygiene students to handle tricky situations. "We've had cases where we picked up on medical or dental problems that other places didn't," she explains. "Students have uncovered situations that merited biopsies or high blood pressure medication, and oral cancers and other tumors. Hygienists can't make diagnoses, but they need to know how diagnoses are arrived at for their licensing. And since City Tech students have a 100 percent pass rate on licensing exams, their patients are getting the best care.

"Because of health care disparities," she adds, "sometimes we're the first health care provider patients see. Many patients in City Tech's dental hygiene clinic lack health insurance, and the clinic fee is only $10 for all treatments except x-rays, no matter how many visits are needed." The clinic's multilingual staff and students often translate for patients whose first language is not English, and students gain invaluable experience from having full patient contact eight to 12 hours each week.

Dr. Cohen-Brown is also the force behind the upcoming "Send a Soldier a Smile" campaign. On April 19, she and student members of the Student American Dental Hygiene Association (SADHA) and the City Tech Student Veterans Club will be collecting thousands of toothbrushes and cash donations, with the proceeds used to send toothbrushes, toothpaste, dental floss and mouthwash to soldiers in Iraq, including battalions that have a connection to the City Tech community.

A longtime resident of Scarsdale, Dr. Cohen-Brown became a dentist because her father was one "and always came home from work happy." One additional professional activity that fulfills her is conducting research. Recently, she became the only dentist ever selected (and the only person chosen from New York this year) to participate in a federally funded program focused on grant writing co-offered by the U.S. Department of Health and Human Services and the Hispanic Association of Colleges and Universities.

She feels City Tech has unique access to a population composed of underrepresented groups whose healthcare issues need systematic study. "I would like to get a pilot study funded to examine the relationships between metabolic syndrome, high blood pressure, diabetes and gum disease in the Hispanic population," she says. "This student research opportunity would put City Tech on the map in a way that hasn't been done before."

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